PCN52 New Insights from CAR-T: An Economic and Organizational Perspective

Abstract

The aim of this study is to analyse, from both economic and organizational perspectives, the different pathways of patients affected by Diffuse Large B Cell Lymphoma (DLBCL) in third-line therapy, with particular emphasis on novel target therapy approaches, as the Chimeric Antigen Receptor T-cell therapy (CAR-T), defining the level of economic sustainability for Italian Hospitals, with a reimbursement tariffs comparison. The economic evaluation considered four different pathways: CAR-T, Allogeneic (Allo-SCT), Autologous Stem Cell Transplant (ASCT) and Best Supportive Care (BSC). Process mapping and Activity Based Costing methodologies were applied, in order to collect the costs related to Allo-SCT, ASCT and BSC pathways, including adverse events. Administrative data on services provided (including diagnostic and laboratory examinations, hospitalizations, outpatients’ procedures and therapies) to 47 third-line patients with lymphoma, were collected in different Italian Hospitals. The CAR-T pathway was mapped and evaluated based on opinions of a panel (9 experts) and literature evidence. Analysis and simulation of the reimbursement tariffs (DRGs) were also conducted. The following average costs were registered, respectively 70,859.85€ only for CAR-T procedure (without considering therapy costs), 51,751.77€ for Allo-SCT, 64,408.92€ for ASCT and 29,558.41€ for BSC. A simulation of the Italian reimbursement tariffs revealed that Allo-SCT and ASCT pathways were sustainable, BSC reimbursement was lower than costs (-16.1%) and the definition of the CAR-T hospitalization tariff need to consider adverse events, for a proper pathway evaluation. In addition, the organizational impact of CAR-T introduction absorbed around 15,000€ in hospital investment (for infrastructures, internal training, meetings and coordination). Results show new economic evidence for healthcare decision-makers, in order to optimize the appropriateness of resources allocation. A specific focus on CAR-T resources absorption suggests the need to introduce a reimbursement tariff dedicated and adequate, both at hospital and NHS level, for the new CAR-T pathway.